Expanded Disability Status Scale Identifies Disability in Patients With and Without MS

Researchers re-evaluated the Expanded Disability Status Scale (EDSS) and its relationship with comorbidities and age in patients with and without MS.

The Expanded Disability Status Scale (EDSS), which assesses the progression of multiple sclerosis (MS), found both older individuals with and without MS to have significant disability. These findings were published in Multiple Sclerosis and Related Disorders.

Researchers from the University of Kansas Medical Center recruited individuals of at least 55 years old (N=106) for this study and assessed them with the EDSS. Participants did (n=51) or did not (n=55) have MS (mean age, 69.29±7.92 vs 70.09±7.66 years, respectively; women, 73% vs 54%, respectively; White, 94% vs 93%, respectively). Between the two groups, the median comorbidities were 5 and 6, and the number of medications were 10 and 8, respectively.

Among patients with MS, 25 had relapsing-remitting MS, 15 had primary progressive MS, and 11 secondary progressive MS. The average time since diagnosis was 24.98 years (Standard Deviation [SD], ±13.6). 28 patients were not on disease modifying therapy, 14 were taking platform injectable medication, and 7 were taking oral medication.

The EDSS correctly identified MS among participants 86% of the time. Median EDSS scores were 6 (interquartile range [IQR], 3) among those with MS and 3 (IQR, 1.5) among those without MS. 18 (32.7%) participants without MS had an EDSS of at least 4.0.

Among the participants without MS, the total scores were significantly different from 0 (P <.001) and significantly associated with functional status systems of bowel/bladder (rs, 0.62; P <.001), ambulation (rs, 0.46; P <.001), brainstem (rs, 0.43; P =.001), and pyramidal (rs, 0.40; P =.003) but not with visual (rs, 0.31; P =.02) or cerebral (rs, 0.24; P =.07). The total scores were significantly greater in patients with MS than the other participants (P <.001) and remained significantly higher after correcting for cofactors (P <.001). Their scores were higher regarding all functional status systems (P <.01) except sensory (P >.1).

Among participants with and without MS, increased disability was associated with older age (P =.001 vs P <.001, respectively). Among those without MS, greater comorbidities (rs, 0.38; P =.005) were associated higher EDSS scores. Lastly, among those with MS, greater comorbidities were associated with the number of medications (rs, 0.49; P <.001).

This study was limited by its low sample size and may have lacked power to significantly detect differences between cohorts.

“These findings indicate that EDSS scores may be partially due to factors other than MS. Our understanding of disease course and disability may benefit from the development of normative EDSS scores to correct for these factors,” concluded the study researchers.

Disclosure: Multiple authors declared affiliations with the pharmaceutical industry. Please refer to the original article for a full list of disclosures.


Lynch S, Baker S, Nashatizadeh M, et al. Disability measurement in multiple sclerosis patients 55 years and older: What is the expanded disability status scale really telling clinicians? Mult Scler Relat Disord. Published online, December 28, 2020. doi:10.1016/j.msard.2020.102724